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Nasal concha

In anatomy, a nasal concha (/ˈkɒnkə/), plural conchae (/ˈkɒnki/), also called a turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like an elongated seashell, which gave them their name (Latin concha from Greek κόγχη). A turbinate bone is any of the scrolled spongy bones of the nasal passages in vertebrates.[1]

Nasal concha

Lateral wall of nasal cavity, showing ethmoid bone in position. (Superior and middle in pink, and inferior in blue.)

In humans, the turbinates divide the nasal airway into 4 groove-like air passages, and are responsible for forcing inhaled air to flow in a steady, regular pattern around the largest possible surface area of nasal mucosa. As a ciliated mucous membrane with shallow blood supply, the nasal mucosa cleans and warms the inhaled air in preparation for the lungs.

A rapidly dilating arteriolar circulation to these bones may lead to a sharp increase in the pressure within, in response to acute cooling of the body core. The pain from this pressure is often referred to as "brain freeze", and is frequently associated with the rapid consumption of ice cream. The shallowness of the venous blood supply of the mucosa contributes to the ease with which nosebleed can occur.

The superior turbinates are smaller structures, connected to the middle turbinates by nerve-endings, and serve to protect the olfactory bulb. The openings to the posterior ethmoidal sinuses exist under the superior meatus.[1]

The middle turbinates are smaller. In humans, they are usually as long as the little finger. They project downwards over the openings of the maxillary and anterior and middle ethmoid sinuses, and act as buffers to protect the sinuses from coming in direct contact with pressurized nasal airflow. Most inhaled airflow travels between the inferior turbinate and the middle meatus.[1]

The inferior turbinates are the largest turbinates, and can be as long as the index finger in humans, and are responsible for the majority of airflow direction, humidification, heating, and filtering of air inhaled through the nose.[1]

The inferior turbinates are graded 1-4 based on the inferior turbinate classification system in which the total amount of the airway space that the inferior turbinate takes up is estimated. Grade 1 is 0-25% of the airway, grade 2 is 26-50% of the airway, grade 3 is 51-75% of the airway and grade 4 is 76-100% of the airway.[3]

There is sometimes a pair of supreme turbinates superior to the superior turbinates. When present, these usually take the form of a small crest.

The turbinates comprise most of the mucosal tissue of the nose and are required for functional respiration. The turbinates are enriched with airflow pressure and temperature-sensing nerve receptors (linked to the "trigeminal" nerve route, the fifth cranial nerve), allowing for tremendous erectile capabilities of nasal congestion and decongestion, in response to the weather conditions and changing needs of the body.[2] In addition, the erectile tissue undergoes an often unnoticed cycle of partial congestion and decongestion called the nasal cycle. The flow of blood to the nasal mucosa in particular the venous plexus of the conchae is regulated by the pterygopalatine ganglion and heats or cools the air in the nose.

The nasopulmonary and nasothoracic reflexes regulate the mechanism of breathing through deepening the inhale. Triggered by the flow of the air, the pressure of the air in the nose, and the quality of the air, impulses from the nasal mucosa are transmitted by the trigeminal nerve to the breathing centres in the brainstem, and the generated response is transmitted to the bronchi, the intercostal muscles, and the diaphragm.

The turbinates are also responsible for filtration, heating, and humidification of air inhaled through the nose. Of these three, filtration is achieved mostly by other more effective means such as mucous and cilia. As air passes over the turbinate tissues, it is heated to 32 - 34 °C (89 - 93 °F), humidified (up to 98% water saturation) and filtered.[2]

The respiratory epithelium that covers the erectile tissue (or lamina propria) of the turbinates plays a major role in the body's first line of immunological defense. The respiratory epithelium is partially composed of mucus-producing goblet cells. This secreted mucus covers the nasal cavities, and serves as a filter, by trapping air-borne particles larger than 2 to 3 micrometers. The respiratory epithelium also serves as a means of access for the lymphatic system, which protects the body from being infected by viruses or bacteria.[1]

The turbinates provide, first and foremost, the humidity needed to preserve the delicate olfactoryepithelium, which in turn is needed to keep the olfactory receptors healthy and alert. If the epithelial layer gets dry or irritated, it may cease to function. This is usually a temporary condition but, over time, may lead to chronic anosmia.[2] The turbinates also increase the surface area of the inside of the nose, and, by directing and deflecting airflow across the maximum mucosal surface of the inner nose, they are able to propel the inspired air. This, coupled with the humidity and filtration provided by the turbinates, helps to carry more scent molecules towards the higher, and very narrow regions of the nasal airways, where olfaction nerve receptors are located.[1]

The superior turbinates completely cover and protect the nerve axons piercing through the cribriform plate (a porous bone plate that separates the nose from the brain) into the nose. Some areas of the middle turbinates are also innervated by the olfactory bulb. All three turbinates are innervated by pain and temperature receptors, via the trigeminal nerve (or, the fifth cranial nerve).[2] Research has shown that there is a strong connection between these nerve endings and activation of the olfactory receptors, but science has yet to fully explain this interaction.

Large, swollen turbinates may lead to blockage of nasal breathing. Allergies, exposure to environmental irritants, or a persistent inflammation within the sinuses can lead to turbinate swelling. Deformity of the nasal septum can also result in enlarged turbinates.[4]

Treatment of the underlying allergy or irritant may reduce turbinate swelling. In cases that do not resolve, or for treatment of deviated septum, turbinate surgery may be required.

There are different forms of turbinate surgery: Somnoplasty - bipolar radiofrequency ablation - a technique used for coblation tonsillectomy, is also used for the treatment of swollen turbinates; reduction by the use of pure heat can be equally effective as can turbinate sectioning. In the case of sectioning, because the turbinates are essential for respiration, only small amounts of turbinate tissue should be removed. Risks of turbinate surgery, including reduction of the inferior or middle turbinates, include empty nose syndrome.[4] Dr. Houser: "this is especially true in cases of anterior inferior turbinate (IT) resection because of its important role in the internal nasal valve."[5]

Concha bullosa is an abnormal pneumatization of the middle turbinate, which may interfere with normal ventilation of sinus ostia and can result in recurrent sinusitis.

The horse breathes through nares (nostrils) which expand during exercise. The nasal passages have two turbinates on either side which increase the surface area to which air is exposed.

1 : Concha nasalis dorsalis

2 : Concha nasalis media

3 : Concha nasalis ventralis

Generally, in animals, nasal turbinates (cochae) are convoluted structures of thin bone or cartilage located in the nasal cavity. These are lined with mucous membranes that can perform two functions. They can improve the sense of smell by increasing the area available to absorb airborne chemicals, and they can warm and moisten inhaled air, and extract heat and moisture from exhaled air to prevent desiccation of the lungs. Olfactory turbinates are found in all living tetrapods,[citation needed] and respiratory turbinates are found in most mammals and birds.

Animals with respiratory turbinates can breathe faster without drying out their lungs, and consequently can have a faster metabolism.[6] For example, when the emu exhales, its nasal turbinates condense moisture from the air and absorbs it for reuse.[7]Dogs and other canids possess well-developed nasal turbinates.[8] These turbinates allow for heat exchange between small arteries and veins on their maxilloturbinate (turbinates positioned on maxilla bone) surfaces in a counter-current heat-exchange system.[8] Dogs are capable of prolonged chases, in contrast to the ambush predation of cats, and these complex turbinates play an important role in enabling this (cats only possess a much smaller and less-developed set of nasal turbinates).[8] This same complex turbinate structure help conserve water in arid environments.[9] The water conservation and thermoregulatory capabilities of these well-developed turbinates in dogs may have been crucial adaptations that allowed dogs (including both domestic dogs and their wild prehistoric gray wolf ancestors) to survive in the harsh Arctic environment and other cold areas of northern Eurasia and North America, which are both very dry and very cold.[9]

Reptiles and more primitive synapsids have olfactory turbinates that are involved in sensing smell rather than preventing desiccation.[10] While the maxilloturbinates of mammals are located in the path of airflow to collect moisture, sensory turbinates in both mammals and reptiles are positioned farther back and above the nasal passage, away from the flow of air.[11]Glanosuchus has ridges positioned low in the nasal cavity, indicating that it had maxilloturbinates that were in the direct path of airflow. The maxilloturbinates may not have been preserved because they were either very thin or cartilaginous. The possibility has also been raised that these ridges are associated with an olfactory epithelium rather than turbinates.[12] Nonetheless, the possible presence of maxilloturbinates suggests that Glanosuchus may have been able to rapidly breathe without drying out the nasal passage, and therefore could have been an endotherm.[6][10][12]

The bones of nasal turbinates are very fragile and seldom survive as fossils. In particular none have been found in fossil birds.[13] But there is indirect evidence for their presence in some fossils. Rudimentary ridges like those that support respiratory turbinates have been found in advanced Triassic cynodonts, such as Thrinaxodon and Diademodon. This suggests that they may have had fairly high metabolic rates.[14][15][16][17] The paleontologist John Ruben and others have argued that no evidence of nasal turbinates has been found in dinosaurs. All the dinosaurs they examined had nasal passages that they claimed were too narrow and too short to accommodate nasal turbinates, so dinosaurs could not have sustained the breathing rate required for a mammal-like or bird-like metabolic rate while at rest, because their lungs would have dried out.[11][18][19] However, objections have been raised against this argument. Nasal turbinates are absent or very small in some birds, such as ratites, Procellariiformes and Falconiformes. They are also absent or very small in some mammals, such as anteaters, bats, elephants, whales and most primates, although these animals are fully endothermic and in some cases very active.[20][21][22][23] Furthermore, ossified turbinate bones have been identified in the ankylosaurid dinosaur Saichania.[24]